Aid Continuing Sample Clauses

Aid Continuing a) Contractor shall be required to continue the provision of the Benefit Package services that are the subject of the fair hearing to an Enrollee (hereafter referred to as “aid continuing”) if so ordered by the NYS Office of Administrative Hearings (OAH) under the following circumstances: i) Contractor has determined to uphold a decision of a PCP to deny a request for a referral, or to deny or reduce a benefit or service, or to authorize the service for less than requested; ii) Enrollee has filed a timely request for a fair hearing with OAH; and iii) There is a valid order for the treatment or service from a Participating Provider. b) Contractor shall provide aid continuing until the matter has been resolved to the Enrollee’s satisfaction or until the administrative process is completed and there is a determination from OAH that Enrollee is not entitled to receive the service; the Enrollee withdraws the request for aid continuing and/or the fair hearing in writing; or the treatment or service originally ordered by the provider has been completed, whichever occurs first. c) If the services and/or benefits in dispute have been reduced and the Enrollee timely requests a fair hearing, Contractor shall, at the direction of either SDOH or LDSS, restore the disputed services and/or benefits consistent with the provisions of Section 25.4 (b) of this Agreement.